膀胱黏膜尿道成形术一期治疗尿道下裂

目的探讨膀胱黏膜尿道成形术一期治疗尿道下裂的疗效.方法 1991年8月～2003年8月对38例先天性尿道下裂患者阴茎下曲矫正后行一期膀胱黏膜尿道成形术治疗.结果 38例均一期成形,术后随访6个月～9年,尿道外口修复至正常阴茎头位置,达到外观美观,恢复正常排尿.其中2例一期手术失败,二期再行膀胱黏膜尿道成形术仍获得成功.一期手术成功率为95%,术后3例尿瘘再行尿瘘修补术,2例轻度尿道狭窄,经尿道扩张后解除.余无并发症.结论一期膀胱黏膜尿道成形术治疗尿道下裂具有并发症少,成功率高等优点.     

尿道下裂手术方式的选择及并发症的预防

目的：评价一期膀胱粘膜或包皮内板在尿道下裂修复术中的应用和并发症的预防。方法：尿道下裂患者164例，年龄1.5-25岁，初次手术病例组138例，采用包皮内板尿道成形术47例，膀胱粘膜尿道成形术91例；再次手术病例组26例，全部采用膀胱粘膜尿道成形术。结果：术后随访6个月－7年。所有病例一次手术成功率（94.5%）。尿瘘9例都位于冠状沟下，初次手术组与再次手术组的成功率（94.9%：92.3%）差异无显著性意义。使用膀胱粘膜与包皮内板尿道成形术成功率（94.1%:95.7%）差异无显著性意义。结论：无论是那种类型的尿道下裂，正确应用包皮内板或膀胱粘膜尿道成形术能取得良好的疗效。手术成功的关键不在于手术的方法，而在于术者对术式掌握的熟练程度和术中以及术后对每个细微环节的认真处理。     

膀胱粘膜移植治疗长段尿道狭窄

本文报告作者１９８４年１０月至１９９３年１０月为１２例长段尿道狭窄（５例为前尿道狭窄，７例为后尿道狭窄）患者施行膀胱粘膜尿道一期成形术。治愈１０例，好转２例。随访半年至９年无特殊。     

膀胱粘膜游离移植一期修复尿道下裂84例

膀胱粘膜游离移植一期修复尿道下裂８４例汪鸿，缪友仁，张维耀，谢庆祥我院自１９８１年至１９９３年６月应用膀胱粘膜尿道成形术一期修复尿道下裂共８４例，效果较好。手术方法一、下曲矫正与其他手术方法无异，沿阴茎腹侧中线切开，于阴茎筋膜与白膜间分离两侧皮瓣，彻...     

带蒂横行包皮内板一期尿道成形术治疗尿道下裂

带蒂横行包皮内板一期尿道成形术治疗尿道下裂杨震，周云，周伟我院在１９９２年１月至１９９４年６月，采用自行改良的带蒂横行包皮内板一期尿道成形术治疗了１８例尿道下裂患儿．手术效果良好。观介绍如下。１资料与方法１．１１陆床资料本组１８例，年龄２～９岁，平均...     

二期膀胱黏膜尿道成形术治疗重型尿道下裂的评价

目的：对膀胱黏膜尿道成形术治疗重型尿道下裂的一期或二期手术疗效进行分析与评价。方法：对1998年1月～2007年10月采用一期或二期膀胱黏膜尿道成形术进行治疗的33例重型尿道下裂进行对照回顾分析。结果：一期膀胱黏膜尿道成形术18例,一次成功率55．6％（10／18）,尿瘘发生率27．8％（5／18）,外口狭窄发生率16．7％（3／18）;二期膀胱黏膜尿道成形术15例,一次成功率66．7％（10／15）,尿瘘发生率13．3％（2／15）,外口狭窄发生率20．0％（3／15）。结论：结合临床观察及相关数据,二期膀胱黏膜尿道成形术在重型尿道下裂的治疗中似具有一定的优势,但尚需继续积累病例,通过有效的统计学分析进一步确证这一推论。     

Duckett术式一期治疗尿道下裂的临床研究

目的:探讨横裁包皮带蒂岛状皮瓣尿道成形术(Duckett术)一期治疗尿道下裂的临床效果。方法:回顾性研究我科2003年～2007年采用Duckett术式一期修复尿道下裂患者20例,年龄2～22岁,平均11.3岁,其中阴茎体型3例,阴茎阴囊型17例;另外收集同期行膀胱粘膜代尿道术尿道下裂30例,年龄7～34岁,平均16.1岁,其中阴茎体型10例,阴茎阴囊型16例,会阴型2例,阴囊型2例。膀胱粘膜术全部行膀胱造瘘及留置尿道支架管,Duckett术仅留置尿道支架管。结果:Duckett术:1次手术成功17例(85%),术后尿瘘2例(10%),尿道狭窄1例(5%),2例尿瘘术后6个月修补成功,人均手术次数为1.1次;膀胱粘膜代尿道术:手术均分二期完成,手术成功26例(86.7%),术后尿瘘3例(10%),尿道狭窄1例(3.3%),再次手术修补瘘口治愈,人均手术次数为2.1次。2例尿道狭窄行尿道扩张后基本痊愈。结论:Duckett术一期修复尿道下裂效果良好,手术成功率与其他术式相近、术后并发症低,与膀胱粘膜尿道成形术相比,术后阴茎外观更满意,主要优点是一次完成手术。     

膀胱粘膜尿道成形术治疗复杂性尿道下裂

目的对膀胱粘膜尿道成形术治疗复杂性尿道下裂的适应证及手术方法进行讨论，以重新认识其应用价值。方法总结2002～2004年经多次手术失败的复杂性尿道下裂7例，平均尿道缺损5、7cm，采用改进后的膀胱粘膜尿道成形术Ⅰ划尿道成形的资料。结果术后均获得较为满意的疗效，阴茎伸直满意，外形好，尿线粗，开口近似正常位置。2例术后尿瘘，6个月后再次修补获成功，手术一次成功率71.4％。结论对多次手术失败、阴茎疤痕严重、局部取材困难、尿道缺损过长的复杂尿道下裂的病例，采用膀胱粘膜尿道成形术Ⅰ期尿道成形仍是目前合理、有效的手术方法。     

游离腹膜移植尿道下裂成形术

１９９５年以来，我们采用游离腹膜移植对２例多次手术失败的尿道下裂患者进行修复，效果良好，现报告如下。１　资料与方法１．１　病例报告例１　男，１６岁，１９９５年１２月入院。５年前曾行ＤｅｎｉｓＢｒｏｗｎｅ术，１年前再次行膀胱粘膜移植尿道下裂成形术，均告失败。体检：阴茎根部可见尿道漏口，阴茎部尿道完全闭塞，为条索状瘢痕组织。行游离腹膜移植尿道下裂成形术。例２　男，４５岁，１９９７年２月入院。曾于２５年和２０年前两次行尿道下裂成形术失败，现排尿困难，尿滴沥。体检：阴茎下屈，尿道口位于阴茎体根部，尿道外…     

游离膀胱黏膜代尿道一期成形术治疗尿道下裂

目的:总结膀胱黏膜代尿道一期成形术治疗尿道下裂的经验,提高治疗水平。方法:对1989～2001年采用膀胱黏膜代尿道一期成形术治疗的52例尿道下裂患者临床资料进行分析。结果:52例尿道外口与正常人相同,43例一次成功,排尿通畅,尿线粗,射程远,占82.7％。并发症9例,占17.3％,经治疗后痊愈。结论:膀就黏膜代尿道一期成形术治疗尿道下裂具有可修复较长的尿道缺损;形成的尿道更趋于生理性;不易形成尿道狭窄等优点。预防并发症要做到熟练掌握尿道下裂的局部解剖,手术操作轻柔准确,从多角度、多面方预防感染。     

Giant prostatic utricle associated with proximal hypospadias: repair by mucosa divesting and muscular tunnel obliteration

Purpose

The purpose of this study was to evaluate the effectiveness of a new approach to repair the giant prostatic utricle (pseudovagina) associated with proximal hypospadias.

Methods

Three patients with giant prostatic utricle associated with proximal hypospadias sought medical advice in our department from 1998 to 2003. The giant prostatic utricles were repaired using the novel approach of divesting of utricular mucosa followed by muscular tunnel obliteration through the opening of the pseudovagina in the dorsal lithotomy position.

Results

Follow-up ranges from 3 to 8 years. The divesting of the prostatic utricle mucosa was successful, and the pseudovagina muscular tunnel was closed completely in all 3 patients. One patient underwent urethroplasty and another repair of urethrocutaneous fistula at the same setting. The third patient underwent a second-stage urethroplasty separately. On follow-up, both the urethral reconstruction and the pseudovagina repair remained successful in all the patients.

Conclusions

The technique of the divesting of the prostatic utricle mucosa and closure of the muscular wall is an effective alternative approach for repairing giant prostatic utricles. It is safe and simple. The surgical exposure is very good.     

尿道下裂分型及与外生殖系统畸形的关系

目的 探讨尿道下裂分型及与合并外生殖系统畸形的相关性.方法 回顾性分析2000年1月至2009年10月收治的632例尿道下裂患者资料,分别统计各型尿道下裂的比例及合并外生殖系统畸形的比例,采用精确概率法及Spearman秩相关分析进行统计学处理.结果 632例尿道下裂患者中,轻度尿道下裂80例(12.6%),中度144例(22.8%),重度273例(43.2%),特重度135例(21.4%).发生阴茎阴囊转位、隐睾、鞘膜积液、隐匿型阴茎、假阴道等外生殖系统畸形共184例次,合并畸形157例,占24.8%.尿道下裂分型与总体畸形、阴茎阴囊转位、隐睾的发生具有统计学意义,并呈正相关;而尿道下裂分型与鞘膜积液的发生无统计学意义.结论 尿道下裂患者以中度以上者占多数,以合并阴茎阴囊转位者最常见,其次为隐睾、鞘膜积液;尿道下裂越严重,合并外生殖系统畸形的概率及发生阴茎阴囊转位、隐睾的概率越高.

Abstract：

Objective To investigate the correlation of the type of hypospadias and external genital system malformations. Methods From Jan 2000 to Oct 2009, the data of 632 patients diagnosed with hypospadias was analyzed retrospectively. The proportion of all types of hypospadias and the frequency of external genital system malformations were statistically analyzed. Results Among all cases, 12.6% exhibited mild hypospadias, 22. 8% moderate, 43. 2% severe and 21.4% had extremely severe hypospadias. One hundred and eighty-four cases with external genital system malformations were classified into penoscrotal transposition, cryptorchidism, hydrocele of tunica vaginalis,concealed penis and pseudovagina. The probability was about 24.8% (157 cases) of 632 patients with hypospadias. There was significant difference and a positive correlation among the type of hypospadias with total malformations, penoscrotal transposition, cryptorchidism. Conclusions In this patient cohort, moderate and severe hypospadias accounted for the majority of hypospadias. Penoscrotal transposition was the most frequent external genital system malformation in hypospadias, followed by cryptorchidism and hydrocele of tunics vaginalis. More severe hypospadias is accompanied with a higher probability of the external genital system malformations, penoscrotal transposition and cryptorchidism.     

Surgical treatment of the malignant mediastinal tumors--with special reference to prosthetic reconstruction of superior vena cava

Sixteen patients with the malignant mediastinal tumors compromising the superior vena cava (SVC) and brachiocephalic veins (BCV) were treated from April 1974 to March 1987. SVC reconstruction by prosthesis combined with or without tumor resection were performed in 6 cases and removal of the tumor with partial resection of SVC and right BCV in one case. Two patients died within one month and two patients survived over 5 years postoperatively. Tumor resection, removal of the right lung and SVC wall, and patch angioplasty were performed in one patient who died three and one half months postoperatively. Resection of the tumor and left BCV were performed in 4 patients. Segmentally resected left BCV was reconstructed with interposed graft in two, prosthesis was implanted between left BCV and right atrium in one and no venous reconstruction was attempted in one. Three patients are alive and one patient died six and one half years after operation. Exploratory mediastinotomy was carried out in 3 cases and radiation therapy alone in one case. All but one patients died within one year after diagnosis. Though the long term results of the surgical treatment for malignant mediastinal tumor was not satisfactory, extensive resection of the tumor was worth attempting, as the patency rate of the prosthetic venous reconstruction was improved.     

应用一体式分叉支架型人工血管腔内治疗腹主动脉瘤42例

目的总结应用一体式分又支架型人工血管治疗腹主动脉瘤初步经验。方法本组42例，其中腹主动脉瘤39例，腹主动脉假性动脉瘤1例，Ⅲ型夹层动脉瘤1例，降主动脉瘤合并腹主动脉瘤1例。除均在腹主动脉放置一体式分又支架型人工血管外，1例降主动脉瘤合并腹主动脉瘤者共放置5枚支架型人工血管，其中4枚直型支架用于隔绝降主动脉瘤；1例Ⅲ型夹层动脉瘤者，降主动脉近侧破口用直型支架型人工血管封堵；1例因一侧髂外动脉闭塞需先经腹膜外切口行人工血管搭桥后才能放置一体式分叉支架。结果平均手术时间50min。1例死亡，8例附加近侧短的覆膜支架，1例附加远侧Cuff，1例近侧和远侧均加Cuff。8例术后有少量内漏，1周后内漏均消失。5例封堵了双侧髂内动脉，20例封堵了单侧髂内动脉，但均未导致臀肌坏死或疼痛等并发症。2例瘤颈与瘤体呈90度角也获得成功。结论一体式分又支架型人工血管可以达到隔绝腹主动脉瘤的作用，且操作更快捷。     

Limb-preserving resection operations in the management of bone tumors of the shoulder region

Authors describe the frequency of bone tumours in the shoulder region and the anatomical characteristics of this region, that are important, regarding tumour surgery. Six cases are reported in whom resection was performed for malignant, semimalignant and benign bone tumours. In their material one primary and two secondary chondrosarcomas, one Ewing's sarcoma, one osteoclastoma and one benign chondroblastoma were found. Follow-up range was 3-7 years. In two patients partial and total scapulectomy was performed, in the later the proximal end of the humerus was resected only, in three of them endoprosthesis was given, and in one case the missing bone was replaced with a fibular graft. The function of the limbs was in every case, even in those in which the replacement of the bone segment was not carried out, adequate. Metastases developed in three patients, two of them were lost, one is alive. The rest of the patients was free of tumour at the follow-up.     

原发性骶前肿瘤的诊断与手术治疗（附8例临床分析）

为探讨原发性骶前肿瘤的诊断和手术方法,分析2007-2010年治疗的8例原发性骶前肿瘤患者的临床资料。结果显示,5例经骶尾部切除,1例经腹切除,1例经腹骶联合切除,1例经腹会阴联合切除。术后病理类型：表皮样囊肿2例,皮样囊肿（良性畸胎瘤）1例,脂肪瘤1例,平滑肌瘤1例,淋巴管囊肿1例,恶性纤维组织细胞瘤1例,恶性畸胎瘤1例。术后无严重并发症。随访12～24个月,无死亡病例。结果表明：（1）直肠指诊、直肠腔内超声、CT检查、MRI检查对术前评估有重要意义;（2）原发性骶前肿瘤应行手术切除,根据肿瘤情况选择手术方法,完整切除肿瘤。     

Tuberculosis of the breast: Report of eight cases

In the 8 cases here reported (Table II), the average age was thirty-two years; youngest twenty years, oldest forty-six years. The nodular type was present in 7, the sclerosing type in one. The left breast was involved in 4, the right in 4. The upper outer quadrant alone was the seat of disease in 2, the inner lower quadrant alone in one, the outer lower quadrant alone in 2, the inner lower quadrant in one, and the outer lower and outer upper quadrants together in 2. The tuberculous mass was fixed in all 8 cases. The overlying skin was attached to the mass in 7 cases and not attached in one case. Pig-skin appearance was present in 6, including the mixed case (II) of carcinoma and tuberculosis, and not present in 2. Retraction of the nipple was present in 5 and not in 3. No case gave a history of discharge from the nipple. The breast was fixed to the chest wall in 5 cases and not so in 3 cases. A sinus was present in 4 cases and absent in 4. Axillary nodes were palpable in 7 cases. Clinical evidence of tuberculosis elsewhere in the body was present in only one case of the 8. The initial symptom was a lump in 6 cases, painful in 2 and not painful in 4 cases of the 6. An acute abscess was the initial symptom in 2 of the 8 cases. Only one case gave a positive past history of tuberculosis and possibly one other (V) who reported adenitis of neck nine years previously. Family history was negative in all cases. Only one case gave a history (VIII) of previous acute inflammation of breast. Five of the 8 cases gave a history of lactation, 6 of the 8 of pregnancy and 2 had never been pregnant. The shortest time from onset to admission to hospital was four weeks: the longest time one and onehalf years. The Wassermann reaction was positive in 3 cases, negative in 4, not recorded in one. The clinical diagnosis was tuberculosis in 2, carcinoma in 6. Tubercle bacilli were demonstrated in none. The diagnosis of tuberculosis of the breast was made by microscopic study of the tissues in all 8 cases. Six of the 8 patients were reported living and well; 1 eight years, 1 four years, 1 two years, and 3 one year each, after the operation. One patient died of shock within twenty-four hours after operation and one (II) died of metastatic cancer fifteen months after operation.     

Perifocal abnormal signal intensity area in MRI in meningiomas

To investigate the perifocal abnormal signal intensity area in MRI in meningiomas, we have analysed MRI in 10 cases among 73 meningiomas which were diagnosed by X-ray CT and verified by operation and pathology. The MRI scanners used in this study were Siemens Magnetom and Toshiba MRT 15A. Ten meningiomas diagnosed by MRI were as follows; one free convexity, one pyramidal, three falx and parasagittal, one sphenoid ridge, one olfactory groove, one cerebellopontine angle, two ventricular meningiomas. Perifocal abnormal signal intensity area was diagnosed as vasogenic edema in 4 cases. This area was shown as high signal intensity in T2-weighted MRI and was confined to the white matter. In proton density-weighted MRI, it was shown as high signal intensity and usually clearly distinguished from rather iso- or hypointensity tumor area. In T1-weighted MRI, this area was shown as slightly low signal intensity, which could be readily differentiated from the remarkably low intensity ventricular CSF. In one case a thin semi-lunar abnormal intensity area bordering the tumor was verified in MRI, but no abnormal area was shown in CT. In the remaining 6 cases, namely one free convexity, one pyramidal and two ventricular meningiomas, one cerebello-pontine and one sphenoid ridge meningioma, in which CSF abutted the tumor, abnormal signal intensity area was diagnosed as entrapped CSF space. The perifocal abnormal signal intensity area in MRI should be regarded as vasogenic edema or entrapped CSF space, and these two should be differentiated by the signal intensity, the distribution of the area and CT-cisternography.(ABSTRACT TRUNCATED AT 250 WORDS)     

Bullet wounds of the carotid axis. Apropos of 4 cases

In three cases, there was an injury of primary carotid artery, and in one case a wound of bifurcation with a large destruction of vessels. In one, there was an A.V. fistula as shoot by the pre of angiogram. Only one patient was in light coma with right hemiplegia and aphasia. Repair was done with a simple suture in one, with a resection and a suture in an other. In two cases an inversed venous grafting was done. In all 4 cases results were satisfactory without any neurologic sequellae.     

Results of treatment for male prolactinomas

We evaluated the results of medical treatment for male prolactinomas. We encountered eight patients with male prolactinomas. The age was 25 to 54 years old (mean 43 years) and the chief clinical symptoms were visual acuity/field defect in three patients, pituitary apoplexy in one patient, disturbance of ejection in one patient, generalized convulsion in one patient, headache in one patient and general fatigue in one patient. The serum prolactin level was 279 to 7,360 ng/ml (mean 2,832 ng/ml). The tumors in all patients were large with a mean diameter of 34.9 mm (range, 21 to 43 mm). In only one patient, the operation was performed due to pituitary apoplexy. All the patients were treated by medication, with bromocriptine being used in seven patients and terguride in one. The follow-up period was 0.8 to 13 years (mean 5.9 years) and, in all patients, the medical treatment was continued. The tumor decreased in size in all patients and the serum prolactin level at the last follow-up observation was 0.5 to 70.5 ng/ml (mean 26.9 ng/ml). All the neurological symptoms disappeared in the early stage of treatment. As for the complications of medical treatment; in one patient, orthostatic hypotension occurred during the initial administration of bromocriptine and one patient suffered CSF leakage two months after the administration of bromocriptine, so the repair of the sella floor by transsphenoidal surgery was necessary. The medical treatment for male prolactinomas is effective for a long term and should be the primary treatment for the male prolactinomas. In conclusion, patients can maintain a good quality of life for a long time by using dopamine agonists.